NPIMap

Organization Active NPI

Clover Family Dentistry, LLC

  • General Practice Dentistry
  • Clover, SC
National Provider Identifier
1346461563
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
1860 Issued in SC
Legal business name
CLOVER FAMILY DENTISTRY, LLC
Practice address
203 Church St
Clover, SC 29710-1008
Phone
(803) 222-4518
Fax
(803) 222-4598
NPI assigned
May 2, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Ernest L Myrick Jr., D.M.D.NPI 1376564872
Title
Member
Phone
(803) 222-4518

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 1860 SC Primary

Addresses

Primary practice location

203 Church St
Clover, SC 29710-1008

Mailing address

203 Church St
Clover, SC 29710-1008
Phone (803) 222-4518

Other identifiers 2

IdentifierTypeStateIssuer
ZX4199MedicaidSC
Z18605MedicaidSC

National Provider Directory

National Provider Directory

Locations

203 Church St
Clover, SC 29710
Phone (803) 222-4518

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1346461563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 CHURCH ST",
            "city": "CLOVER",
            "state": "SC",
            "postal_code": "297101008",
            "telephone_number": "803-222-4518",
            "fax_number": "803-222-4598"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 CHURCH ST",
            "city": "CLOVER",
            "state": "SC",
            "postal_code": "297101008",
            "telephone_number": "803-222-4518",
            "fax_number": "803-222-4598"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLOVER FAMILY DENTISTRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MYRICK",
        "authorized_official_first_name": "ERNEST",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "803-222-4518",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "1860",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZX4199",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Z18605",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clover, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.